Overcoming Feelings of Impotence The Competent Patient

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The decision to initiate new treatments after relapse has to be taken by the patient. In order to face a new series of treatments, it is necessary that the patient expresses his or her readiness to enter a new treatment phase. An important element in overcoming the first feelings of impotence after relapse is to perceive that there is a choice. Indeed, a patient may or may not accept a new treatment line. Choice is a powerful tool to overcome feelings of impotence; this is one of the reasons why this choice has to be left to the patient and why clinicians should not present the situation as if there is only one option. Not only from a psychological point of view, but also from a legal and ethical point of view, the patient has the right to refuse further treatments. In order to present this choice to the patient in an adequate way, the clinician first has to accept that there is such a choice and that there are patients who may refuse a treatment, even if this seems, from a medical point of view, to be the wrong decision. As long as patients are competent, they have the right to choose. Unfortunately, there is still confusion about competency of the patient and there are still clinicians who believe that a patient is incompetent if he or she makes decisions which are unreasonable from a medical point of view, or if he or she suffers from psychiatric disturbances; both situations are not a proof of incompetence (Markson et al. 1994). Clinicians who ignore these facts and who are ambivalent about patients refusing treatment are at risk of breaking the laws when putting pressure on patients to continue treatments. They are also counterproductive from a psychological point of view, since they deny the choice of the patient and enhance feelings of "being treped" and feelings of impotence.

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